University of San Francisco - NURS 320

Chapter 05: Cultural Issues

Keltner: Psychiatric Nursing, 8th Edition

MULTIPLE CHOICE

1)A nurse begins work at an agency that provides care to members of a minority ethnic population. What intervention should the nurse implement to demonstrate cultural competence?

1. 1. Identifying popularly held culture-bound issues
   2. Implementing scientifically proven interventions
   3. Correcting inferior health practices of the population
   4. Exploring commonly held beliefs and values of the population

2. A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge?
   1. Knowledge is acquired through use of affective or feeling senses.
   2. Knowledge is acquired according to proof of existence.
   3. Knowledge develops by striving for transcendence of the mind and body.
   4. Knowledge evolves from an individual’s relationship with a supreme being.

3. The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?
   1. Patients of different cultural groups may metabolize medications at different rates.
   2. Metabolism of psychotropic medication is consistent among various cultural groups.
   3. Differences in hepatic enzymes will influence the rate of elimination of psychotropic medications.
   4. It is important to provide patients with oral and written literature about their psychotropic medications.

4. A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. What issue should the nurse focus upon initially?
   1. If the patient’s immunizations are current
   2. The patient’s religious preferences
   3. The patient’s specific ethnic group
   4. Whether there is a need for an interpreter

5. A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore what personal characteristic?
   1. Chi

1. 2. Meridians
   3. Equilibrium
   4. Divine relationships

6. The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after what intervention?
   1. Focusing on the parents rather than the child
   2. Arranging to feed the child warm foods
   3. Looking deeply into the child’s eyes
   4. Consulting by a root doctor or native healer

7. A Hispanic parent reports, “An old woman gave my baby the evil eye.” After it’s determined that the infant is physically healthy. What intervention will be most culturally competent in resolving the parent’s concern?
   1. Assuring the parent that the baby is healthy and needs no treatment
   2. Explaining that the evil eye is a superstition and not a cause of illness
   3. Encouraging the parent to immerse the baby in a cool water bath for 5 days
   4. Offering to arrange a healer to see the child

8. A patient of Hispanic descent is hospitalized with depression. Considering the traditional cultural world view, which intervention is most applicable to care planning for this patient?
   1. The nurse should confer with the family’s oldest woman, who will serve as the primary decision maker.
   2. With the patient’s permission, the nurse should consult with family and religious

advisors to plan care.

1. 3. The plan of care should incorporate use of meditation and contemplation techniques.
   4. Acknowledge that Western medical treatment will be readily accepted by the patient.

9. A nurse notes abrasions on a baby’s thighs and determines that skin scraping has been used by the parents. In an effort to use cultural negotiation, the nurse should implement which intervention?
   1. Encouraging the use of less pressure during scraping to prevent abrasions and infections
   2. Showing the parent how to use moxibustion rather than skin scraping
   3. Explaining that skin scraping does not effectively treat illness
   4. Cautioning that the scraped skin can become easily infected

10. A Hispanic patient says, “I have no energy and cannot eat. I want to sleep but can’t, because pain moves around different parts of my body.” A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing which culturally bound illness?
    1. Lost soul (susto)
    2. Spiritual distress
    3. A broken heart
    4. Amok

11. A Hispanic patient reports symptom of culminate  the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of

selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with what cultural intervention?

1. 1. A traditional healer
   2. Acupuncture
   3. Skin scraping
   4. Moxibustion

12. A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse’s most appropriate initial intervention?
    1. Ask if the parent has used coining on their child.
    2. Report the parent for suspected child abuse.

1. 3. Assess whether the parent desires to harm the child.
   4. Ask if the parent has taken the child to an acupuncturist.

13. A parent said, “My child had mal ojo, so I did not give her the medicine for an ear infection.” The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse should recognize that the situation occurred because of what factor?
    1. Lack of knowledge of therapeutic regimen
    2. Differences in perceptions of how illness occurs
    3. Evidence of unconscious hostility toward the child
    4. A misunderstanding about the communicability of microbes

14. A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools while keeping sessions short and concise. After the group session, what conclusion will the patients most likely arrive at regarding the session based on their likely relational worldview?
    1. The nurse was uncaring.
    2. The session was effective.
    3. The teaching was efficient.
    4. They were treated respectfully.

15. A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which intervention should be implemented next?
    1. Verify understanding by asking the patient to restate the information.

1. 2. Ask if the patient is willing to follow directions for medications.
   3. Reinforce cultural norms about eating hot and cold foods.
   4. Provide the information in written form to the patient.

16. A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with the consumers with an ecologic worldview?
    1. Silence is considered a social error.
    2. Touching is an accepted part of conversation.
    3. Important topics are always preceded by polite social conversation.
    4. Rules regarding roles and status are important and must be observed.

17. A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence?
    1. Serve the patient a cold beverage at the beginning of the interview.
    2. Review Middle Eastern cultural values before the interview.
    3. Avoid offering to shake hands with the patient.
    4. Determine if a translator is available.

18. An African-American patient tells a nurse with a European-American worldview, “There’s no sense talking. You wouldn’t understand because you live in a white world.” What is the nurse’s best response In order to build the nurse-patient relation?
    1. “Nurses are educated to care for people from all cultures. It is a required component of nursing education.”

1. 2. “It would be helpful if you described an example of something you think I would not understand.”
   3. “Your mental illness is causing you to view me with prejudice. We are all here to help you.”
   4. “Yes, I do understand. Everyone goes through the same experiences.”

19. A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient’s self-esteem, but after 3 weeks the patient’s eye contact was unchanged. What is the accurate analysis of this scenario?
    1. The patient’s poor eye contact indicated anger and hostility that did not resolve.
    2. The nurse should have assessed the patient’s culture before formulating this diagnosis and plan.
    3. Resolution of shame and guilt cannot be expected to occur in 3 weeks. The nurse should allow more time.
    4. The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye contact.

20. When a Mexican-American woman and female nurse interact, the patient often holds the nurse’s hand or links arms with the nurse. Which analysis of this behavior demonstrates the nurse’s understanding of this behavior?
    1. The patient is using touch to make the nurse uncomfortable and manipulate the relationship based on that factor.
    2. An energy field disturbance has occurred. Touch rebalances the energy between the patient and nurse.
    3. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
    4. The patient is accustomed to and comfortable with touch, as are members of many Hispanic cultures.

21. At the time of discharge, a patient with a European-American analytic worldview demands copies of all medical records. Which truth about the patient’s values most accurately explains the patient’s behavior?
    1. Continues to experience mistrust of the team’s truthfulness.
    2. Is probably planning to see an attorney about poor care.
    3. Values the written evidence of illness and treatment.
    4. Probably wants to edit the records for accuracy.

MULTIPLE RESPONSE

1. Which questions should the nurse ask to determine an individual’s worldview? (Select all that apply.)
   1. “What is more important: the needs of an individual or the needs of a community?”
   2. “How would you describe an ideal relationship between individuals?”
   3. “How long have you lived at your present residence ?
   4. “Of what importance are possessions in your life?”
   5. “Do you speak any foreign languages?”

2. A nurse cares for patients who recently immigrated to the United States. The nurse would expect patients from which countries to hold relational worldviews? (Select all that apply.)
   1. Germany
   2. Panama
   3. Mexico
   4. Ghana
   5. France